Does Somatosensory-Evoked Potential Simultaneously Decrease with Transcranial Motor-Evoked Potential Alarm? A Multicenter Study by the Monitoring Committee of the Japanese Society for Spine Surgery and Related Research
Introduction: Multimodal intraoperative neurophysiological monitoring (IONM)―such as monitoring muscle-evoked potentials after transcranial electrical stimulation (Tc-MEP) with somatosensory-evoked potential (SEP) after electrical stimulation of the peripheral nerve―is recommended in spine surgeries...
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The Japanese Society for Spine Surgery and Related Research
2025-03-01
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| Series: | Spine Surgery and Related Research |
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| Online Access: | https://www.jstage.jst.go.jp/article/ssrr/9/2/9_2024-0229/_pdf/-char/en |
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| author | Hideki Shigematsu Go Yoshida Hiroki Ushirozako Kenta Kurosu Nobuaki Tadokoro Masahiro Funaba Shigenori Kawabata Jun Hashimoto Muneharu Ando Shinichirou Taniguchi Masahito Takahashi Naoki Segi Hiroaki Nakashima Shiro Imagama Shinji Morito Kei Yamada Tsunenori Takatani Tsukasa Kanchiku Yasushi Fujiwara Hiroshi Iwasaki Kanichiro Wada Naoya Yamamoto Kazuyoshi Kobayashi Akimasa Yasuda Kazuyoshi Nakanishi Yasuhito Tanaka Yukihiro Matsuyama Katsushi Takeshita |
| author_facet | Hideki Shigematsu Go Yoshida Hiroki Ushirozako Kenta Kurosu Nobuaki Tadokoro Masahiro Funaba Shigenori Kawabata Jun Hashimoto Muneharu Ando Shinichirou Taniguchi Masahito Takahashi Naoki Segi Hiroaki Nakashima Shiro Imagama Shinji Morito Kei Yamada Tsunenori Takatani Tsukasa Kanchiku Yasushi Fujiwara Hiroshi Iwasaki Kanichiro Wada Naoya Yamamoto Kazuyoshi Kobayashi Akimasa Yasuda Kazuyoshi Nakanishi Yasuhito Tanaka Yukihiro Matsuyama Katsushi Takeshita |
| author_sort | Hideki Shigematsu |
| collection | DOAJ |
| description | Introduction: Multimodal intraoperative neurophysiological monitoring (IONM)―such as monitoring muscle-evoked potentials after transcranial electrical stimulation (Tc-MEP) with somatosensory-evoked potential (SEP) after electrical stimulation of the peripheral nerve―is recommended in spine surgeries to prevent iatrogenic neurological complications. However, the effect of using Tc-MEP with SEP to protect against neurological complications, particularly motor function, remains unknown. In clinical settings, changes due to Tc-MEP meeting the alarm points must be a potential neurological injury. This retrospective study, focusing on true-positive (TP) cases, aimed to clarify the change in the SEP waveform simultaneously with the Tc-MEP alarm.
Methods: We included 68 patients with TP who had Tc-MEP changes and new postoperative motor weakness at more than one level of the manual muscle test after surgery. We compared the cases based on the category of spine surgery and paralysis type. We evaluated sex, age at spine surgery (high- or non high-risk), and paralysis type (segmental, long tract, or both). We defined the alarm points as follows: >70% decrease in Tc-MEP wave amplitudes, >50% decrease in wave amplitudes, or 10% extension of SEP latency. Next, we evaluated the SEP wave changes with a Tc-MEP alarm.
Results: All patients showed progressive motor weakness after surgery, and 21 patients (31%) showed SEP changes at the same time as the Tc-MEP alarm. There were no statistically significant differences in the ratio of SEP change between the two groups according to the spine surgery category or among the three groups according to the paralysis type.
Conclusions: Multimodal IONM is an important tool. However, the SEP changes do not necessarily appear immediately after the Tc-MEP alarm. Spine surgeons should appropriately treat Tc-MEP alarms to preserve motor function, regardless of SEP changes. |
| format | Article |
| id | doaj-art-4ffd09e2abaf41cba5b626d4d15b6c94 |
| institution | OA Journals |
| issn | 2432-261X |
| language | English |
| publishDate | 2025-03-01 |
| publisher | The Japanese Society for Spine Surgery and Related Research |
| record_format | Article |
| series | Spine Surgery and Related Research |
| spelling | doaj-art-4ffd09e2abaf41cba5b626d4d15b6c942025-08-20T02:11:34ZengThe Japanese Society for Spine Surgery and Related ResearchSpine Surgery and Related Research2432-261X2025-03-019217317810.22603/ssrr.2024-02292024-0229Does Somatosensory-Evoked Potential Simultaneously Decrease with Transcranial Motor-Evoked Potential Alarm? A Multicenter Study by the Monitoring Committee of the Japanese Society for Spine Surgery and Related ResearchHideki Shigematsu0Go Yoshida1Hiroki Ushirozako2Kenta Kurosu3Nobuaki Tadokoro4Masahiro Funaba5Shigenori Kawabata6Jun Hashimoto7Muneharu Ando8Shinichirou Taniguchi9Masahito Takahashi10Naoki Segi11Hiroaki Nakashima12Shiro Imagama13Shinji Morito14Kei Yamada15Tsunenori Takatani16Tsukasa Kanchiku17Yasushi Fujiwara18Hiroshi Iwasaki19Kanichiro Wada20Naoya Yamamoto21Kazuyoshi Kobayashi22Akimasa Yasuda23Kazuyoshi Nakanishi24Yasuhito Tanaka25Yukihiro Matsuyama26Katsushi Takeshita27Department of Orthopedic Surgery, Nara Medical UniversityDepartment of Orthopedic Surgery, Hamamatsu University School of MedicineDepartment of Orthopedic Surgery, Hamamatsu University School of MedicineDepartment of Orthopedic Surgery, Hamamatsu University School of MedicineDepartment of Orthopedic Surgery, Kochi UniversityDepartment of Orthopedic Surgery, Yamaguchi UniversityDepartment of Advanced Technology in Medicine, Biomedical Engineering Laboratory, Institute of New Industry Incubation, Institute of Science TokyoDepartment of Advanced Technology in Medicine, Biomedical Engineering Laboratory, Institute of New Industry Incubation, Institute of Science TokyoDepartment of Orthopedic Surgery, Kansai Medical UniversityDepartment of Orthopedic Surgery, Kansai Medical UniversityDepartment of Orthopedic Surgery, Kyorin UniversityDepartment of Orthopedic Surgery, Nagoya University Graduate School of MedicineDepartment of Orthopedic Surgery, Nagoya University Graduate School of MedicineDepartment of Orthopedic Surgery, Nagoya University Graduate School of MedicineDepartment of Orthopedic Surgery, Kurume University School of MedicineDepartment of Orthopedic Surgery, Kurume University School of MedicineDivision of Central Clinical Laboratory, Nara Medical UniversityDepartment of Orthopedic Surgery, Yamaguchi Rosai HospitalDepartment of Orthopedic Surgery, Hiroshima City North Medical Center Asa Citizens HospitalDepartment of Orthopedic Surgery, Wakayama Medical UniversityDepartment of Orthopedic Surgery, Hirosaki University Graduate School of MedicineDepartment of Orthopedic Surgery, Tokyo Women's Medical University Medical Center EastDepartment of Orthopedic Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini HospitalDepartment of Orthopedic Surgery, National Hospital Organization Saitama HospitalDepartment of Orthopedic Surgery, Nihon UniversityDepartment of Orthopedic Surgery, Nara Medical UniversityDepartment of Orthopedic Surgery, Hamamatsu University School of MedicineDepartment of Orthopedic Surgery, Jichi Medical UniversityIntroduction: Multimodal intraoperative neurophysiological monitoring (IONM)―such as monitoring muscle-evoked potentials after transcranial electrical stimulation (Tc-MEP) with somatosensory-evoked potential (SEP) after electrical stimulation of the peripheral nerve―is recommended in spine surgeries to prevent iatrogenic neurological complications. However, the effect of using Tc-MEP with SEP to protect against neurological complications, particularly motor function, remains unknown. In clinical settings, changes due to Tc-MEP meeting the alarm points must be a potential neurological injury. This retrospective study, focusing on true-positive (TP) cases, aimed to clarify the change in the SEP waveform simultaneously with the Tc-MEP alarm. Methods: We included 68 patients with TP who had Tc-MEP changes and new postoperative motor weakness at more than one level of the manual muscle test after surgery. We compared the cases based on the category of spine surgery and paralysis type. We evaluated sex, age at spine surgery (high- or non high-risk), and paralysis type (segmental, long tract, or both). We defined the alarm points as follows: >70% decrease in Tc-MEP wave amplitudes, >50% decrease in wave amplitudes, or 10% extension of SEP latency. Next, we evaluated the SEP wave changes with a Tc-MEP alarm. Results: All patients showed progressive motor weakness after surgery, and 21 patients (31%) showed SEP changes at the same time as the Tc-MEP alarm. There were no statistically significant differences in the ratio of SEP change between the two groups according to the spine surgery category or among the three groups according to the paralysis type. Conclusions: Multimodal IONM is an important tool. However, the SEP changes do not necessarily appear immediately after the Tc-MEP alarm. Spine surgeons should appropriately treat Tc-MEP alarms to preserve motor function, regardless of SEP changes.https://www.jstage.jst.go.jp/article/ssrr/9/2/9_2024-0229/_pdf/-char/entc-mepsepalarm pointwave amplitudelatencyhigh-risk spine surgery |
| spellingShingle | Hideki Shigematsu Go Yoshida Hiroki Ushirozako Kenta Kurosu Nobuaki Tadokoro Masahiro Funaba Shigenori Kawabata Jun Hashimoto Muneharu Ando Shinichirou Taniguchi Masahito Takahashi Naoki Segi Hiroaki Nakashima Shiro Imagama Shinji Morito Kei Yamada Tsunenori Takatani Tsukasa Kanchiku Yasushi Fujiwara Hiroshi Iwasaki Kanichiro Wada Naoya Yamamoto Kazuyoshi Kobayashi Akimasa Yasuda Kazuyoshi Nakanishi Yasuhito Tanaka Yukihiro Matsuyama Katsushi Takeshita Does Somatosensory-Evoked Potential Simultaneously Decrease with Transcranial Motor-Evoked Potential Alarm? A Multicenter Study by the Monitoring Committee of the Japanese Society for Spine Surgery and Related Research Spine Surgery and Related Research tc-mep sep alarm point wave amplitude latency high-risk spine surgery |
| title | Does Somatosensory-Evoked Potential Simultaneously Decrease with Transcranial Motor-Evoked Potential Alarm? A Multicenter Study by the Monitoring Committee of the Japanese Society for Spine Surgery and Related Research |
| title_full | Does Somatosensory-Evoked Potential Simultaneously Decrease with Transcranial Motor-Evoked Potential Alarm? A Multicenter Study by the Monitoring Committee of the Japanese Society for Spine Surgery and Related Research |
| title_fullStr | Does Somatosensory-Evoked Potential Simultaneously Decrease with Transcranial Motor-Evoked Potential Alarm? A Multicenter Study by the Monitoring Committee of the Japanese Society for Spine Surgery and Related Research |
| title_full_unstemmed | Does Somatosensory-Evoked Potential Simultaneously Decrease with Transcranial Motor-Evoked Potential Alarm? A Multicenter Study by the Monitoring Committee of the Japanese Society for Spine Surgery and Related Research |
| title_short | Does Somatosensory-Evoked Potential Simultaneously Decrease with Transcranial Motor-Evoked Potential Alarm? A Multicenter Study by the Monitoring Committee of the Japanese Society for Spine Surgery and Related Research |
| title_sort | does somatosensory evoked potential simultaneously decrease with transcranial motor evoked potential alarm a multicenter study by the monitoring committee of the japanese society for spine surgery and related research |
| topic | tc-mep sep alarm point wave amplitude latency high-risk spine surgery |
| url | https://www.jstage.jst.go.jp/article/ssrr/9/2/9_2024-0229/_pdf/-char/en |
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